Vaginal leiomyoma mimicking a Cystocele (report case)

Leiomyoma, known as a disease of the uterus, composed of spindle-shaped smooth muscle fibers and collagenous stroma, is rarely encountered in other sites especially in the vagina.

We report, here, an exceptional case of a vaginal leiomyoma situated in the anterior vaginal wall suggesting in the first place a cystocele. The MRI objectified a rounded formation of the anterior wall of the vagina with regular contours highly suggestive of a vaginal leimyoma. The tumor was surgically removed by the vaginal route. The histopathologic examination confirmed the diagnosis of vaginal leiomyoma.

Vaginal leiomyomas are commonly seen in women between the ages of 35 and 50 and are believed to be more common in Caucasian women. Although a rare tumor, vaginal leiomyomas may present with a variety of clinical features and may be mistaken preoperatively for a cystocele, urethrocele, Skene's duct abscess, Gartner's duct cysts, urethral diverticulum, vaginal cysts, cysts Bartholin's gland or a malignant vaginal tumor. The diagnosis is based on careful examination and preoperative imaging (ultrasonography and MRI). Removal of the tumor by vaginal route, wherever possible, with subsequent histopathological examination appears to be the optimum management plan. Although the lesion is benign, local recurrences following incomplete resection and sarcomatous changes have been reported.

Vaginal leiomyoma is a rare benign tumor. The diagnosis is often made only postoperatively after resection of the mass. The tumors may be found in any location within the vagina but are most commonly located on an anterior wall. Imaging can confirm the vaginal origin of the lesion. Surgical excision is the treatment of choice. The diagnosis is based on the histological study of the tumor.